NO.________________________________________Post
NO.__________
NAME______________________________________________________________________________________
ADDRESS___________________________________________________________________________________
PHONE________________________________CELL
________________________________________________
DEPARTURE
DATE_________________________RETURN DATE_____________________________________
TYPE
OF PREMISE: RESIDENCE__________________BUSINESS__________________OTHER___________
HAVE
KEYS BEEN LEFT WITH ANYONE? YES_____________NO_____________
IF
YES, NAME_________________________________ADDRESS_____________________________________
PHONE#______________________________________
WILL
ANYONE BE WORKING OR HAVE ACCESS TO PREMISES DURING YOUR
ABSENCE?_____________
IF
YES, NAME________________________________________________________________________________
IN
CASE OF EMERGENCY DO YOU WISH TO BE NOTIFIED BY COLLECT
CALL? YES_________NO_______
C/O
NAME_________________________________ADDRESS__________________________________________
PHONE#__________________________________
I
REQUEST A SECURITY CHECK BE MADE OF MY PREMISES AND AGREE
TO NOTIFY YOU OF MY RETURN.
SIGNED_________________________________________DATE
OF REQUEST______________________
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